Balamuthia amebic encephalitis: radiographic and pathologic findings

The radiographic findings of two patients (one, a rare survivor) with meningoencephalitis caused by Balamuthia mandrillaris are presented with pathologic correlation.     

肺硬化性血管瘤的影像学与病理学对照研究

目的回顾性分析肺硬化性血管瘤(PSH)的影像学表现，并与病理学对照，旨在提高对PSH影像表现的认识。方法1976年1月至2002年12月由手术及病理证实的PSH共45例，其中男3例，女42例(93．3％)，年龄18～67岁，中位年龄49岁。无症状由体检发现19例(42．2％)。影像学资料(包括胸部正、侧位X线片和CX)完整的PSH共20例。平扫7例，直接增强扫描13例。将影像表现与病理对照。结果典型X线片表现为圆形、卵圆形边界清楚的肿物或结节，无分叶及毛刺。CT平扫7例，病变密度与肌肉密度相仿。直接增强扫描13例，9例为均匀强化(其中4例增强早期呈不均匀强化，延时后均匀强化)，4例呈不均匀强化，强化程度略高于或明显高于肌肉密度，强化的最大CT值为135HU。13例增强CT的病变中，强化程度高于或明显高于肌肉的11例，全部含有较多的血管瘤成分。含有较大面积低密度区的1例，组织学显示有囊变。影像检查见有钙化的5例均与病理学所见吻合。结论有助于PSH影像诊断的指标为：(1)40-60岁的女性患者；(2)胸片上表现为圆形、卵圆形边界清楚的肿物或结节；(3)CT平扫密度均匀，有时有小低密度区和粗大点状钙化，偶尔可见囊性变；(4)CT增强后有中度至明显强化。对于增强早期呈明显不均匀强化的圆形、卵圆形边界清楚的肿物或结节，应行延时扫描。     

Chronic diverticulitis: clinical, radiographic, and pathologic findings

OBJECTIVE: The purpose of our study is to present a series of 14 patients with chronic diverticulitis on barium enema examinations and to correlate the radiographic findings with the clinical and pathologic findings in these patients. CONCLUSION: Chronic diverticulitis is a distinct pathologic entity characterized by the frequent development of chronic obstructive symptoms and abdominal pain rather than the classic clinical findings of acute sigmoid diverticulitis. Barium enema examinations usually reveal a relatively long segment of circumferential narrowing in the sigmoid colon with a spiculated contour and tapered margins, sometimes associated with retrograde obstruction. Our experience suggests that chronic diverticulitis can often be diagnosed on the basis of the characteristic clinical and radiographic findings in these patients.     

Benign bronchopulmonary tumors: radiologic and pathologic findings

According to the new World Health Organization classification, benign bronchopulmonary tumors can be classified into epithelial tumors, mesenchymal tumors, and tumor-like conditions. Imaging findings of benign tumors of large airways are nonspecific and overlapping. Some benign pulmonary tumors show characteristic imaging findings. On CT, bronchioloalveolar adenomas appear as a small nodular area of ground-glass opacity. Metastasizing leiomyomas are seen as well-circumscribed solitary or multiple pulmonary nodules ranging in size from a few millimeters to several centimeters. Pulmonary hamartomas or lipomas are recognized specifically when fat deposits of CT number in the -80 HU to -120 HU range are identified. Enhancement of tumor with administration of contrast medium with or without foci of calcification may be seen in sclerosing hemangiomas and hemangiopericytomas. Awareness of the various imaging findings of these tumors can help narrow down the differential diagnosis on daily practice among the long lists of bronchopulmonary tumors.     

肺不典型腺瘤样增生的影像与病理对照分析

目的分析肺不典型腺瘤样增生（AAH）的影像表现，并与病理对照，旨在提高对AAH影像表现的认识。方法回顾性分析由手术及病理证实的8例AAH的影像表现，所有患者均摄X线胸片并经高分辨率CT（HRCT）及增强扫描，均为女性，中位年龄56岁。由影像科医师及病理科医师共同阅片，将影像学结果与病理学结果进行对照分析。结果胸部正侧位片3例未检出病变，5例参照CT可以辨别出小类结节或淡片影。CT8例均见肺结节影，其中右肺上叶4例，右肺中叶1例，右肺下叶1例，左肺上叶2例。最大20．0mm×18．1mm，最小5．0mm×4．1mm。HRCT均为非实性结节，密度不均匀，平均CT值最高为一-362．7HU，最低为-485．6HU，平均为（-423．0±47．0）HU；4例可见空气支气管征、空泡。病变均为类圆形，边界较清晰，边缘有浅分叶者2例。未见毛刺征和胸膜牵拉征。镜下表现为结节边界清楚，与周围肺组织分界明显；肺泡间隔轻度增厚，上皮细胞沿肺泡间隔增生，细胞间排列紧密，但无重叠及挤压；核质比例轻度失调，有轻度异形性。结论有助于AAH影像诊断的指标为：（1）偶尔发现的肺结节，无症状；（2）病变通常直径≤10mm；（3）HRCT表现为非实性结节，可有空泡或空气支气管征；（4）HRCT无毛刺征和胸膜牵拉征等表现。最终确诊仍需组织学证据。     

Small bowel tumors: spectrum of findings on 64-section CT enteroclysis with pathologic correlation

Improvements in helical technology have made detection of benign and malignant small bowel tumors easier so that they are now frequently detected at an early stage. Sixty-four-section CT enteroclysis provides suggestive features that help determine the actual nature of a small bowel tumor in a large number of cases. Specific diagnosis of small bowel tumor is based on a combination of findings that are depicted owing to the use of the multiple capabilities of 64-section CT enteroclysis, allowing optimal planning prior to endoscopic or surgical resection.     

Atypical benign lipomatous tumors in the soft tissue: radiographic and pathologic correlation

This article describes the characteristic imaging findings and correlates them with the pathology in the nonfatty regions of benign atypical lipomatous tumors, which have different findings compared with typical lipomas and well-differentiated liposarcomas. For differentiating these tumors from typical lipomas and well-differentiated liposarcomas, it may be helpful to analyze nonfatty regions in benign atypical lipomatous tumors.     

Spectrum of neurogenic tumors in the thorax: CT and pathologic findings.

Neurilemomas and neurofibromas appear as round soft tissue masses at CT. Variable enhancement with either homogeneity or heterogeneity is seen in neurilemomas. Attenuation of the tumors on enhanced CT depends on histology: the extent of Antoni A or B tissue and the amount of myxoid or cystic degeneration or hemorrhage. Neurofibromas are usually homogeneous low attenuation lesions on unenhanced CT. They show homogeneous enhancement or early central blush on enhanced scan. The extent of enhancement depends on the proportions of tumor components: nerve sheath cells, collagen bundles, and areas of myxoid degeneration. Malignant nerve sheath tumors show variable attenuation. Bony destruction, pleural effusion, and metastatic pulmonary nodules may also occur. Ganglioneuromas appear as oblong homogeneous low attenuation lesions on both enhanced and unenhanced CT. This low attenuation is due to their pathologic components, with an abundant amount of myxoid matrices and a relatively small amount of ganglion cells. Neuroblastomas appear as aggressive soft tissue lesions with calcification. Ganglioneuroblastomas may appear with features in between those of ganglioneuromas and neuroblastomas. The typical location of the posterior mediastinum or the aortopulmonary window and high enhancement with administration of contrast medium at CT suggest the diagnosis of paragangliomas.     

Low-grade gastric mucosa-associated lymphoid tissue lymphoma: correlation of radiographic and pathologic findings.

PURPOSE: To describe upper gastrointestinal (Gl) examination findings of low-grade gastric mucosa-associated lymphoid tissue (MALT) lymphoma and to correlate them with pathologic examination findings. MATERIALS AND METHODS: A retrospective review of upper Gl examinations was performed in 25 patients with proved low-grade gastric MALT lymphomas. Upper Gl examinations were reviewed for common findings and most probable diagnosis, and these findings were correlated with pathologic findings in resected specimens in 15 patients. RESULTS: The common findings at upper Gl examination included mucosal nodularity (n = 13), ulcer (n = 12), rugal thickening (n = 6), mass (n = 4), and enlarged areae gastricae (n = 2). The most probable diagnoses were early gastric carcinoma (n = 7), advanced gastric carcinoma (n = 6), gastritis (n = 9), and lymphoma (n = 3). Of 17 lesions found on resected specimens, six ulcers and two masses were not depicted at barium study. Disorganized convergent rugae projecting to multiple points and vague ulcer margins were present in four and seven lesions, respectively. Multiple ulcers were seen in two patients. CONCLUSION: Although the common radiographic and pathologic findings observed in low-grade gastric MALT lymphomas were similar to those of gastric carcinomas or gastritis, disorganized convergent rugae, vague ulcer margins, and multiplicity of lesions may be helpful in differentiating them from gastric carcinomas or gastritis.     

Small cell carcinoma of the colon: barium study and CT findings

Extrapulmonary small cell carcinoma is a rare neoplasm. It is an aggressive malignant tumour characterized by rapid local progression and early metastasis. We report a case of small cell carcinoma arising in the transverse colon in a 34-year-old man who presented with epigastric pain. On CT, a poorly enhancing bulky mass encircling the transverse colon with extensive regional lymph node metastases was observed. A segmental annular narrowing with thick interhaustral folds of the transverse colon was found by barium enema examination. This is the first report of barium study and CT findings of extrapulmonary small cell carcinoma of the colon.     

重视平坦型大肠肿瘤的临床诊治

平坦型大肠肿瘤包括表浅型大肠肿瘤及凹陷型大肠肿瘤,与大肠癌发生有密切相关的特殊性。表浅型大肠肿瘤以大肠侧向发育型肿瘤(1aterally spreading tumor,LST)为代表;凹陷型大肠肿瘤以凹陷型早期大肠癌(Ⅱc型早期大肠癌)为代表。平坦型大肠肿瘤由于在临床上难以发现,在我国尚未被临床医师普遍认知,因此有关报道极少。近年来,南方医院在做肠镜检查中对平坦型大肠肿瘤的检出和诊疗上创造与积累了一些自己的经验,他们认为,提高大肠平坦型病变征象的识别和染色内镜的应用是发现大肠平坦型病变的关键,黏膜剥离术和分析黏膜剥离术是诊治大肠平坦型病变的最佳方法之一,而且已着手开展对平坦型大肠肿瘤发生发展的基础研究工作。     

Neuronal tumors of the central nervous system: radiologic findings and pathologic correlation.

Pure neuronal and mixed neuronal-glial tumors of the central nervous system are uncommon but fascinating because they are less aggressive than the more common glial tumors and their prognosis is excellent. Neurologic manifestations are varied and include seizures, symptoms of increased intracranial pressure, and neurologic deficits according to tumor location. Many neuronal tumors of the central nervous system demonstrate characteristic radiologic findings. At magnetic resonance (MR) imaging, gangliocytomas demonstrate low signal intensity on T1-weighted images, high signal intensity on T2-weighted images, and frequent enhancement on gadolinium-enhanced T1-weighted images. Characteristic MR imaging findings of Lhermitte-Duclos disease are a nonenhancing mass in a cerebellar hemisphere with a striated pattern. Central neurocytomas are typically located in the lateral ventricles near the foramen of Monro with a characteristic attachment to the septum pellucidum. Ganglioneurocytoma is a rare variant of central neurocytoma that is characterized by differentiation toward ganglion cells. In ganglioglioma, a well-defined cystic mass with a solid mural nodule is typically seen. Extension of enhancement to the leptomeninges is characteristic of desmoplastic infantile ganglioglioma and correlates with the firm dural attachment of the solid component. Dysembryoplastic neuroepithelial tumor has a well-demarcated, multilobulated or gyriform appearance.     

Primary non-odontogenic tumors of the jawbones: an overview of essential radiographic findings

The jawbones, namely the maxilla and mandible, can be the sites of a multitude of neoplastic conditions. Given the variety of processes affecting this particular anatomic area, formulation of a precise diagnosis often can be challenging to the radiologist and the clinician, who may not be familiar with the imaging findings fundamental to diagnosis. Although advanced imaging methods have been developed, routine radiography remains the mainstay in the initial assessment of osseous lesions involving the jawbones. We review and summarize the imaging appearances of non-odontogenic tumors of the jawbones and illustrate example cases of these uncommon neoplasms of bone. Detailed patient history, physical examination, laboratory evaluation and histopathologic analysis are of paramount importance in diagnostic approach and, in most cases, are to be considered in the imaging evaluation of a given lesion. Correct interpretation of the imaging features of lesions involving the jawbones suggests the diagnosis, aids in presurgical planning and improves patient management.     

Small bowel obstruction caused by snail's shell: radiographic and CT findings

We report a case of small bowel obstruction in a 74-year-old woman presenting with abdominal pain due to the accidental swallowing of a snail shell. A diagnosis of obstruction was made by abdominal radiograph, and its etiology was found after abdominal CT was performed. This is an unusual case of small bowel obstruction due to a foreign body that was preoperatively diagnosed with imaging.